Reperfusion Arrhythmias in Man: Influence of Intravenous Lidocaine

Abstract

To assess the efficacy of prophylactic lidocaine treatment in the prevention of ventricular tachyarrhythmias after recanalisation of an occluded coronary artery, 49 patients with acute myocardial infarction undergoing intra-coronary thrombolysis were studied. The patients were admitted to the hospital within 3 h of the onset of symptoms and were randomised into 2 groups: 23 patients received, after a loading dose of 200 mg, 2 mg min−1 intravenous lidocaine (group A), whereas the other 26 did not (group B). Reperfusion arrhythmias occurred in 16 of 20 successfully recanalised patients in Group A, and in 15 of 21 successfully recanalised patients in group B. There was no difference between the groups in the incidence of ventricular tachycardia and fibrillation. Regardless of lidocaine treatment, two types of ventricular tachycardia could be distinguished. The first, and most frequent, type was associated with electrophysiologic properties characteristic of enhanced automalicity, whereas the other type of tachycardia had characteristics suggesting re-entry or triggered activity as the underlying mechanism. Our findings indicate that intravenous lidocaine, in the dosage given here, is ineffective in preventing either type of reperfusion tachycardia or fibrillation in man.